Provider Demographics
NPI:1477569572
Name:MCCARTY, TARA BECKER (MCD)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:BECKER
Last Name:MCCARTY
Suffix:
Gender:F
Credentials:MCD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ELIZABETH
Other - Last Name:BECKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MCD
Mailing Address - Street 1:PO BOX 6069
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29171-6069
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:146 N HOSPITAL DR
Practice Address - Street 2:STE120
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4800
Practice Address - Country:US
Practice Address - Phone:803-936-7530
Practice Address - Fax:803-936-7532
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3401231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP4644OtherMEDICAID GROUP NUMBER
SCSA0761Medicaid